Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.79 / $116.38 / $390.10	Facility	26	$75.79	$116.38	$390.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $228.11 / $257.52 / $454.05	Professional		$228.11	$257.52	$454.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.79 / $95.38 / $155.81	Professional	26	$75.79	$95.38	$155.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $145.65 / $165.09 / $293.02	Professional	TC	$145.65	$165.09	$293.02
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $217.18 / $273.52 / $410.33	Professional		$217.18	$273.52	$410.33
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.51 / $95.11 / $142.66	Professional	26	$75.51	$95.11	$142.66
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.66 / $178.42 / $267.64	Professional	TC	$141.66	$178.42	$267.64
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $248.79 / $268.22 / $831.57	Professional		$248.79	$268.22	$831.57
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $88.11 / $95.02 / $179.59	Professional	26	$88.11	$95.02	$179.59
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $155.41 / $155.41 / $293.74	Professional	TC	$155.41	$155.41	$293.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.46 / $93.46 / $93.46	Facility	26	$93.46	$93.46	$93.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $237.84 / $340.59 / $583.25	Professional		$237.84	$340.59	$583.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $82.51 / $117.00 / $213.57	Professional	26	$82.51	$117.00	$213.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $150.49 / $207.32 / $369.69	Professional	TC	$150.49	$207.32	$369.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $218.93 / $270.44 / $330.94	Professional		$218.93	$270.44	$330.94
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $72.79 / $92.48 / $114.95	Professional	26	$72.79	$92.48	$114.95
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $141.66 / $180.53 / $222.67	Professional	TC	$141.66	$180.53	$222.67
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $99.99 / $109.08 / $225.36	Facility	26	$99.99	$109.08	$225.36
Medcost Facility/Professional Professional Modifier Low / Median / High Price $112.40 / $231.00 / $439.00	Professional		$112.40	$231.00	$439.00
Sentara Facility/Professional Professional Modifier Low / Median / High Price $120.88 / $300.37 / $521.48	Professional		$120.88	$300.37	$521.48
Sentara Facility/Professional Professional Modifier 26 Low / Median / High Price $90.63 / $120.56 / $183.57	Professional	26	$90.63	$120.56	$183.57
Sentara Facility/Professional Professional Modifier TC Low / Median / High Price $167.13 / $224.85 / $349.61	Professional	TC	$167.13	$224.85	$349.61
United Facility/Professional Professional Modifier Low / Median / High Price $193.04 / $299.04 / $462.22	Professional		$193.04	$299.04	$462.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.54 / $105.81 / $170.39	Professional	26	$69.54	$105.81	$170.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.37 / $189.28 / $292.97	Professional	TC	$122.37	$189.28	$292.97